Abstract
OBJECTIVES: To investigate the association between cardiovascular health scores (CVH) based on Life's Essential 8 (LE8) and 90-day functional prognosis of patients with acute ischemic stroke (AIS) and explore the mediating role of laboratory indicators to provide evidence for secondary stroke prevention. METHODS: This multicenter, prospective cohort study was conducted among 599 AIS patients within 72 h of onset. The clinical data of the patients were collected, and the cardiovascular health (CVH) scores were calculated according to LE8 criteria. Functional prognosis of the patients at 90 days were assessed by telephone follow-up using the modified Rankin scale score (mRS), whose correlation with the total LE8 score and each individual item score were analyzed using multiple linear regression. Lasso regression analysis was used to select laboratory markers associated with 90-day mRS, and their mediating role in the LE8-outcome relationship were assessed using the Bootstrap method. RESULTS: After adjusting for confounders, the total LE8 score was found to inversely correlate with 90-day mRS score of the patients (β=-0.05, 95% CI: -0.06‒-0.041; P<0.001). The scores of 7 LE8 components (exercise, diet quality, nicotine exposure, sleep, body mass index, cholesterol, and blood pressure) were inversely correlated with 90-day mRS scores (all P<0.05). Among the laboratory parameters, fibrinogen (FIB) was positively correlated (β=0.215, 95% CI: 0.068‒0.361; P=0.0041) while MCHC (β=-0.012, 95% CI: -0.022‒-0.002; P=0.0229) and HRR (β=-0.007, 95% CI: -0.013‒0.00; P=0.042) were negatively correlated with 90-day mRS scores. FIB significantly mediated the relationship between LE8 scores and 90-day mRS scores with an indirect effect of -0.0019 (95% CI: -0.00381‒0.00; P=0.006) and a mediation proportion of 3.778% (95% CI: 0.00869‒0.08). CONCLUSIONS: The CVH scores assessed by LE8 are inversely correlated with 90-day functional prognosis of AIS patients, suggesting the importance of maintaining good CVH for improving stroke outcomes. FIB, MCHC and HRR levels are inversely correlated with the patient prognosis, and FIB partially mediates the impact of LE8 scores on stroke outcomes.